There are countless unknowns still swirling around the Affordable Care Act. Its ultimate price tag is anyone’s guess. Thanks to the Supreme Court’s decision to make the ACA’s Medicaid expansion optional, there’s no way to predict how many uninsured people will gain new coverage. But one of the biggest mysteries shrouding the law is whether state or federal authorities are better suited to manage the insurance exchanges that will regulate and organize individual and small group health insurance policies once the law is fully in effect in 2014.

In a move that boxed in Republican governors who rail against federal intrusion, the authors of the ACA left the crucial job of exchange management to the states. At the same time, the ACA says the federal government will run exchanges for states which don’t set up their own. This clever gambit left red-state governors with a Sophie’s choice of sorts. They could set up insurance exchanges and participate in the implementation of one of the most divisive laws in modern American politics. Or they could refuse, and invite the federal government into their insurance regulatory apparatus, which has historically been governed at the state level.

The Democrats in charge of the Department of Health and Human Services would be happy either way. Controlling more exchanges would be beneficial to advancing their regulatory priorities; ceding control to states would probably save money on IT costs over the long run. (The exchanges will be run through web sites, on which individuals and small groups will be able to compare plans and buy insurance policies.) Either way, the ACA insurance regulations written by the feds would have to be followed.

So which undesirable path have Republican governors taken? Well, some opted to run their own exchanges, concluding it would be better retain some power over how Obamacare plays out in their states. Others have said they can’t in good conscience endorse, even implicitly, any element of the controversial health care law. And in the wake of Barack Obama’s re-election and the high likelihood Obamacare is here to stay, some Republican governors still haven’t been able to decide which choice is better for them politically, as well as for their state budgets and populations in the long run.

Those waffling governors have said they needed more time and more information from the federal government on how exactly exchanges are supposed to work. So this week, HHS Secretary Kathleen Sebelius extended the deadline that states have to make their decisions until Dec. 16. In the meantime, GOP leaders have begun making decisions. Republican Gov. Scott Walker has decided to let the feds set up the exchange in Wisconsin; Republican Gov. Rick Scott has indicated he may reconsider his staunch opposition to a Florida-run exchange. In Mississippi, Republican Gov. Phil Bryant opposes a state-run exchange, but the state insurance commissioner is moving forward on one anyway. (For a relatively up-to-date look at which states have opted in and out of running exchanges, see the Wall Street Journal’s map here.)

In a rare moment of consensus, several liberal and conservative health-policy watchers are saying fed control is the better way to go. Jon Walker, a writer at the liberal web site Firedoglake, says more federal control will be more efficient, and argues exchanges would be better run by officials invested in the success of Obamacare. Michael Cannon, of the libertarian Cato Institute, opposes Obamacare, but cites as-yet-unknown costs for states if they choose to run exchanges; he says the feds have so much control over the insurance regulatory apparatus that state control won’t mean much anyway. It’s a rare example of consensus from both sides of the political spectrum on the issue of health care reform.

Health insurance as it is today does not serve America well either in cost, services or access. It only makes sense for the governors to opt for federal management of the exchanges. That streamlines operations and saves money over the long run. This plan is not a magic bullet that will immediately reduce the cost of healthcare, but will slow down the sometimes astronomical increases each year. Best of all, it gives most everyone healthcare and forces businesses that were trying to phase out employee healthcare coverage or limit benefits and raise co-pays dramatically to finally participate fully, It may cost a little more for such businesses, but I think raising prices a few percentage points does not usually run customers away, and they will have much happier workers, which always helps.

As Democrats continue to bask in the post-election schadenfreude ofwatching Republicans weep and gnash their teeth at losing thepresidential election, the sense that conservatives are the architectsof their own misery is only enhancing liberal glee. It seems the initialshock hasn’t warn off: In a conference call with his fundraising team,Mitt Romney is still blaming his loss on those freeloading Americans who wanted stuff.

Clearly, the only explanation for all this delusion is that conservative mediaand campaign consultants, steeped in years of confidently lying abouteverything from global warming to the causes of the deficit, got alittle too bold about their ability to create their own realities. Theonly question is whether conservatives will learn their lesson andexhibit more skepticism about their self-selected news media in thefuture.

The answer is almost surely no, for a very good reason:Conservative credulousness is so baked into the culture of the rightthat it could well be considered a defining feature. This has been truefor as long as movement conservatism as we know it has existed, andthere’s no real reason to think conservatives are going to sharpen upabout this now.

Before the election, historian Rick Perlstein published an essay examining the long history of intra-conservative con artistry in The Baffler,with a heavy focus on the way conservative publications and mail-orderfundraisers exploit audience gullibility to sell people snake oil andconvince them to give to “causes” that never see much, if any, of themoney. Perlstein’s aim was to explain why it is that conservativesdidn’t seem to mind Romney’s nonstop lying, even though his constantlychanging positions made it unclear which lie he’d be backing if he evermade it to the presidency. Perlstein argued that after years of trainingthemselves to enjoy the garbage shoveled out by their media outlets,conservatives have come to rely on lying as a kind of comfort blanket, away to know that they are with their own people.

It’s time, in other words, to consider whether Romney’s fluidity with thetruth is, in fact, a feature and not a bug: a constituent part of hisappeal to conservatives. The point here is not just that he lies when hesays conservative things, even if he believes something different inhis heart of hearts — but that lying is what makes you sound the way aconservative is supposed to sound, in pretty much the same way thatcurlicuing all around the note makes you sound like a contestant onAmerican Idol is supposed to sound.

There are post-election lessons to be learned from how movement conservatism haslong housed weirder claims than run-of-the-mill climate-changedenialism. Perlstein cites examples such as claiming naps cure cancerbetter than chemo or that grandmothers can trust their dollars are goingto Bibles in Africa when they’re simply being pocketed by fundraisers. Stanley Kubrick mocked this tendency in Dr. Strangelovewhen a character repeats a popular ’60s-era right-wing urban legendabout fluoridated water being communist mind control. (This fear stillhaunts the right, as demonstrated by Georgia state senators convening a meeting last month todiscuss Obama’s supposed communist mind-control plot.) The lesson inall this for the rest of us: Right-wingers don’t really have the samerelationship to the truth that we do. They aren’t just creating theirown truth for comfort but also to mark themselves as members of thetribe.

One major economic benefit that always goes ignores because it is difficult to calculate is the vast reduction in health-related bankruptcies. It's difficult to say how much the economy loses each year because of whole families going bankrupt due to medical costs, but it's got to be quite a bit. Removing that drain on the economy will likely have far reaching if difficult to calculate benefits.

@outsider2011 Mitt Romney is an eastern liberal Republican. He's not a conservative. He was the governor of MA hardly a conservative state there Outy.

Of course there is climate change. The climate on earth has changed many, many times over billions of years. Earth used to be frozen solid. In fact, the latest warming period has allowed for humanity to thrive in areas that were once frozen tundras. How horrible. Since we are still in that warming period, I bet it's gong to get hotter....hmm maybe I should write a book and make a movie, claim that I have discovered something and sell it to pinheads that don't know any better.

@outsider2011 I think it boils down to this: as long as you have that magic R after your name, it doesn't matter what you say. Just toss out a little red meat now and then, give the dog whistle (or, lately, bullhorn) an occasional toot, keep the anger and resentment at a steady boil, and, voila, you're King of the Shrinking Base.

I agree about Romney - he had to make himself appeal to the base - but that undermined his entire campaign. Every politician changes according to what will get them elected; but most don't change absolutely everything they say - and within minutes of saying it.

As for the rest of your post, it helps make the point i was referencing below.

Logi and i were discussing actual issues. There were no insults, merely a discussion.

@53_3@superlogi Of course I will. My nut has already been made. It's my children and their children I'm concerned about. In fact, I'm even worried about your children who will end up getting the invoices.

An interesting and side-related concept: skin-heads, neo-nazis, goths, ICP followers, and so on, all go to great pains to cultivate a very dramatic outward appearance that is as recognizable and repulsive as possible to 'outsiders'. The psychological origin of this practice is very similar: by marking yourself as part of a persecuted clan you feel closer to those are persecuted with you--partly because you know you share what they are going through as far as daily ostracism and whatnot as well as because they know they have made an extreme commitment to the cause by outing themselves so dramatically, so they are thus more trustworthy within their circle.

Sharing feelings of being ostracized is a powerful connector among those feel disaffected by society.

@Sue_N@outsider2011 When life is over, and one makes a final examinatin -- accepting one's imperfections and misdeeds -- one (or at least I) can take great comfort in being able to say two things in my defense:

@outsider2011@Sue_N True. It's a bizarre mentality; a seige mentality. "We have to hunker down behind our walls so the advancing hordes don't get us." It's just a ridiculous argument that, in this country, the rich and white people are "oppressed minorities," yet that's the argument that binds them together. "Those people are coming to take our stuff!"

It's also a losing proposition. A party built on the fear and resentment of angry old white people is setting the stage for its own demise.

@outsider2011 outsider2011 Well, the parasites and class envy warriors certainly did. With regard to me putting people on the streets, you need to change your brand of glue because the your f00l had nothing to do with protecting jobs. His only concern was to protect UAW for votes and campaign assistance. Furthermore, you should check what the CBO says about Barry's tax and spend policies, before blaming someone else for them.

@ARTRaveler ARTRaveler All wars are paid for, but very few are budgeted for simply because unless you're a progressive, you're not clairvoyant.PS By their very nature taxes are a collection of resources which are never paid for. The problem is, the insatiable appetites progressives have for them. Oh, and during Desert Fox (Clinton's bombing of Iraq) I was living in Russia and during the beginning of Bush's war, I was working in Moldova. But I don't see that has anything to do with anything. And last but not least, your messiah has accomplished more that twice the deficit spending Bush did in just one term.

@53_3 That's exactly right. Funding a failed Company and/or its marketing department is not Barry's job. And, the fact is since there was no increase in the market for cars, why on earth would overall employment requirements be effects by that market? Short answer. It wouldn't. The point is, Barry's claim and yours that he saved the US Car industry is ludicrous on its face.

@53_3@superlogi Don't take it personally, I'd hate anyone who would take from being a "free market" capitalist economy to becoming a Marxist Utopia. With regard to people making more money than you do, they don't owe you a thing, yet they're (2%) already paying close to 50% of all income taxes. Your buff00n thinks that's fair because he has the notion government owns all wealth, to be divided back into the population as he sees fit, primarily to purchase votes for his ideology. Furthermore, Marx is one of Barry's favorites and his ideology has caused more misery, death and destruction than all the wars and pestilence in recorded human history in less than a century. And, you talk about Ken Mehlman a one time Republican party chair who no one on either sides even remembers. And only a numerically impaired progressive would think Barry's taxes increases on the wealthy will raise $1.6 trillion. The fact is, you and people like have this idea that you deserve a piece of a pie that's already been baked, when what you deserve is the piece you bake. Now, some people can't bake and we have to take care of them, but not only would you and Barry take care of people who can bake, but provide much more care than is reasonable for people who can't.

superlogi, were you outside complaining when Bush 2 gave two unpaid for tax cuts or started two unpaid-for wars. If you weren't, you have no reason to have the right to complain about the national debt since the bulk of the $10.7 trillion that Bush 2 left us was run up during good times just so they could give tax cuts to groups that were obviously doing very well already (the top 0.5-1.0%).

Deficit spending to get over a depression like the one that Bush 2 left makes sense. To do other wise is bad financial handling of the government and with all the GOTP smarts, you would think it wouldn't have happened but maybe the GOTP isn't really the party of fiscal discipline-just fiscal insanity!

If you want candid conversation, you need to be candid as well. You're arguing your points about class etc warfare assuming that you can maintain denial of GOP practices. Mehlman, the former GOP head, in 2008 apologized for Southern Strategy specifically.

I've boded that here because you MUST presume, without denial, your party's responsibilities before any sensible discussion can take place.

But I'll give you a discussion anyway:

Obama is going to include tax cuts for the rich. That's 1.6 trillion dollars in much needed help in paying down debt. I don't see how you can justify any position where I'm asked to make more sacrifices (I will, bitw) if the higher incomes don't kick in.

And please, don't give me that "they already pay" argument. We're talking about resources to pay the debt down: money. I don't have much, they have a lot.

So in short, your arguments are based on things that you are not honest about.

@outsider2011@superlogi@53_3 If Barry didn't increase or maintain the market for cars, how did he save the industry? What he did, is save the UAW. That's it. With regard to getting more people insured, he got other people to pay for something those 30 million should have paid for themselves. And, of course, it works for you, but I wouldn't brag about it.

@outsider2011@superlogi@53_3 Not only did the mendacious buffoon define the "middle class" down, but he ensured its demise. If you don't understand that, just look at what he's accomplished in his time in office. Get use to it. It's not over.

In 2012, class warfare broke out in American politics. And from the president to key Senate races, the middle class won.

When the 2012 campaign began, the lousy economy made President Obamavulnerable. Republicans were favored to take back the Senate, given retirements in conservative states. Republican billionaires — the Kochbrothers, Adelson and others — put up big money in the effort to have itall. Instead the president swept to victory, and Democrats gained seatsin the Senate and the House.

Many factors contributed.Republicans learned once more the shortcomings of a stale, male, pale, Southern-based party in a nation of diversity. The GOP “legitimate rape”caucus helped give away two Senate seats. But too little attention hasbeen paid to the new emerging reality. This was the first class warfareelection of the new Gilded Age — and the middle class won big.

The Republican nominee Mitt Romney was inescapably the candidate of, by andfor the 1 percent. He came from the world of finance and carried theiragenda. He won the primaries, as Newt Gingrich complained, because hehad more billionaires than anyone else. And the rich right were on awilding, not only funding the Romney campaign, but also filling thecoffers of super PACs and their offspring with hundreds of millions ofdollars.

The class war, ironically, broke out in the Republican primaries. After Romney’s victory in New Hampshire, Newt Gingrich and Rick Perry savaged Romney as a “vulture capitalist,” the “man from Bain” who profited from breaking up companies, shipping jobs abroad, and leaving a broken carcass behind. Romney’s negatives soared, reaching the highest on record.

And of course Romney reinforced the impression with revealing moments that exposed his yacht club cluelessness: “Corporations are people, my friends”; “I like firing people”; elevators for his cars; the $10,000 bet; $375,000 in speaking fees “isn’t a lotof money”; trying to appeal to Bubba because he knows a lot of NASCARowners. He secreted his past income tax statements, while the one herevealed exposed a 14 percent tax rate on over $20 million in income,with, in the imitable phrase of former Ohio Governor Ted Strickland, hismoney “wintering in the Cayman Islands and summering in the SwissAlps.”

Needless to say, Obama is neither by temperament nor predilection a populistclass warrior. But faced with potential defeat, he turned to what works.The depths of the Obama presidency came in the summer of 2011 after thedebt ceiling debacle, in which the president was roughed up by TeaParty zealots, and emerged looking weak and ineffective.

Obama came back by deciding to stop seeking back-room compromises with peopleintent on destroying him and to start making his case. In the fall, heput out the American Jobs Act and stumped across the country demandingthat Republicans vote on it. His standing in the polls began to rise.Then Occupy Wall Street exploded, driving America’s extreme inequalityand rigged system into the debate. In December, the president embracedthe frame: He traveled to Osawatomie, Kansas, revisiting a campaign stopTeddy Roosevelt had made in the first Gilded Age. He indicted the“you’re on your own” economics of Republicans while arguing that “thisis a make-or-break moment for the middle class, and for all those whoare fighting to get into the middle class.

”In the run-up to the election, the president’s campaign employed two basic strategies. First, the president consolidated his own coalition. He defended contraceptionand pay equity while his campaign attacked the Republican “war onwomen.” He reached out to Hispanics by ending the threat of deportationfor the Dream kids. He not only ended “don’t ask, don’t tell,” but alsomoved to embrace gay marriage. Widely described as socially liberalmeasures, these were also profoundly bread-and-butter concerns. Couldwomen choose when to have children? Could Hispanic children be free topursue the American dream? Could gay people gain the economic benefitsof marriage?

At the same time, the president’s campaign made arisky but remarkably successful decision. Their opinion research showedthat painting Romney as a flip-flopper had little traction, but theattacks on vulture capitalism hit home. They decided to spend big moneyearly in such key states as Ohio on a negative ad barrage definingRomney as the heartless vulture capitalist from Bain. Both campaignsbelieve that Romney never recovered.

@53_3@superlogi It will take generations to pay off our spending excesses. So, it will definitely affect your family, unless your real name is Bill Gates. You think any of Obama's ideas have been balanced? He won the election by dividing and conquering with class envy, gender, ethnic and race warfare and promises of additional "things" to each of those classes. Balanced? Hardly. What he did is make promises, those of us who are paying for the government, can't keep, particularly since it's obvious he's punishing us into the poor house.

I have to agree. At least it is a sane response, but I think superlogi's "worries" are misplaced when extended to my family. Nice hook, but I'm not buying the whole "debt disaster" thing because Obama plans to approach that in a balanced fashion, which, barring GOP obstructionism again, will eventually be a success.

@ahandout@outsider2011@superlogi@53_3 ahandout outsider2011 superlogi 53_3 The pie appears to be baked, particularly when you hear comments from the likes of Harry Reid that he is absolutely unwilling to reform entitlements. So, "my feeling is", that the wanting outweighs the paying for it, at least until people like Marc Zandy and Paul Krugman admit they were wrong. By the way, I'm not holding my breath.

We don't think with emotions for example. Therefore, we are only concerned that the country cannot afford Obamacare on top of all the other deficit spending. It's not an emotional argument to get upset about, Outy. It's based on economics. The part that is truly concerning is that liberals don't care; they just want what they want, and if they don't get it then they get angry, for example: The riots in Europe.

Liberals "feel" instead of think, hence your reference to "upset." Because that's the way your brain works. It's actually pretty funny that you laid your response out in a way that totally defines the way that liberals "feel."

@outsider2011@superlogi@53_3 Romney wanted to allow the choice of vouchers or the present system and the voucher value would not have been fixed any more than COLA would cease to exist. With regard to cutting spending, it isn't a choice. It is merely a when it will happen and how much each item will be cut. If you don't understand that, you're part of the problem. It's also not a matter of preserving the safety net, it's a matter of how much you provide to the safety net. With regard to defense spending, certainly it can and must be done more efficiently, but it is, easily, our most important priority as a government. Without national security, all else is meaningless. You talk of manner, yet the White House's idea of sequester came about from Jack Lew, Obama's current Chief of Staff. It wasn't a bad idea. It just wasn't applied across the board. In fact, it was only applied to discretionary spending and that was unfortunate because it left mandatory spending which amounts to well over 60% of the budget, untouched. The bottom line is this. While Barry is in office, he will either knowingly or unknowingly run this country's economy into the ground. How do I know? Because he's already made a good run at it.

I think - and this is supposition on my part - that the idea of the math not working is how it's applied.

Romney wanted to use Ryans plan for vouchers for retirees, right? But while those vouchers have a fixed value, the rates of healthcare increase. Thus the vouchers are not enough.

Sure you can increase the voucher value - but i don't believe it would happen.

I think your point about who would cut federal spending is interesting - in that you it falls to what you consider important.

Because while it's true Romney would have cut the social net, Obama is cutting defense spending. That's government spending too.

And that's where the ideological divide is. Because Dems (i'm generalizing, because there are exceptions on both sides) want to preserve the safety net, while cutting defense (which can be cut dramatically while maintaining the most powerful Armed forces in the world), where as Repubs want to cut spending to the social net, and maintain (or in Romney's case increase) defense spending.

I think that is where it breaks down; because i'm sure you'd argue for at least maintaining defense spending (or possibly increasing it - i am not going to speak for you) and i think the safety net should be maintained.

That it could be run better i'm not arguing. But i don't think blanket, across the board cuts are the answer.

But again, the idea of reducing the debt and deficit isn't something we're arguing about. It's the manner.

And unless either side can come up with a better argument than any of us have heard so far, the problem is going to remain.

@outsider2011@superlogi@53_3 @outsider2011 @superlogi @53_3 A typo. Two things, Romney's cuts would have included decreasing Federal spending to no more than 20% of GDP. It's, currently, 25%. 5% of GDP is roughly 750 billion/yr. The tax cuts were roughly 10% less than current marginal rates. His highest rate would have been ~28% with cuts in deduction making it revenue neutral and capped on the wealthiest to ensure that. Simpson/Bowles highest rate was 24% with similar deductions. Now, that's roughly twice the cuts Obama's proposal was (is) over ten years. Not only that, but Barry's counting on $2 trillion of fictional cuts that won't be spent anyway (primarily on wars we won't be involved in). The bottom line is, Barry's cuts would have been a fuzzy $2 trillion against Mitt's $7.5 trillion over the same period. Now, those were the plans, but considering past history, who would you believe would be more apt to cut federal spending?

PS My marginal tax rate is 28%, but my effective rate is just over 20%. As income increases, less deductions, effective rates become more similar to marginal rates. In short, yes the wealthy would have paid more, much more. The fact is, the wealthiest 400 families in NYC pay an effective tax rate of around 16%. Given either the Bowles or Romney plans, they would have paid much much more. And any fool, who tells you that's not mathematically possible is either mathematically illiterate or just a partisan hack.

Either way, it remains to be seen. You're assessment that things will be painful is not in dispute. But the studies show that Romney would not have paid down either the deficit or the debt; just let more people hurting.

Doesn't matter; the point i was making was that people can talk without having to be nasty about it - which is what i was pointing out you did (not being nasty in your post).

@outsider2011@superlogi@53_3 If anything Romney would have cut too much, too quickly and created even more immediate and excruciating pain. What you've got instead, is kicking the can down the road, exploding deficits, defunding defense, increasing consumer costs and even more unemployment. Whatever path would have been taken would have been painful. Romney's was of the quick and dirty variety, Barry's is more like dying by a thousand cuts allah the European style.